IDA Eligibility Questionnaire

IDA Eligibility Questionnaire

NeighborImpact HomeSource
NeighborImpact is an equal opportunity provider and employer. If you require accommodation, please contact 541-548-2380 or reception@neighborimpact.org. If you are hearing impaired, please dial TYY 711.

Si prefiere una copia en español, llame al 541-548-2380.
Applicant Information
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Do you live within city limits?

YesNo
County/Territory*

DeschutesCrookJeffersonConfederated Tribes of Warm SpringsOther
Questionnaire
What is your primary savings goal?*

BusinessEducationHome PurchaseVehicle
Did an agency/organization refer you to the IDA program?*

YesNo
Which agency/organization?*
What is your household’s estimated Gross (BEFORE taxes) monthly income?*
What is your credit score? (as currently known)*
How long have you been working at your current employer/business? (if you have more than one employer, indicate length in the one that pays most of your wages)*
If you have been in your current employment/self-business less than 1.5 years, please explain what was your working situation before that. Were any gaps of employment? How long was the gap?*
How much do you have in savings?*
What is your total estimated monthly debts? (min payment for each credit card that you have, car loans, personal loans, student loans etc.?) *
Has anyone in your family ever owned a home in the U.S.? (Family defined as yourself, current partner, parents, grandparents, or grandparents-in-law)*

YesNo
Have you participated in the State Funded Matched Savings (IDA) program before?*

YesNo
When?*
Race and Ethnicity*

African American/BlackAmerican Indian/Alaskan NativeAsianHispanic/LatinoNative Hawaiian/Pacific IslanderWhiteOther

IDA Eligibility Questionnaire

Applicant Information

Questionnaire

Submission